President Donald Trump signed an executive order Thursday aimed at expanding Americans’ access to health insurance choices, the first official step of his pledge to tackle health-care reform solo after repeated congressional failures to pass legislation repealing Obamacare.
“We’ve been hearing about the disaster of Obamacare for so long,” the president said. “Since I’ve started running and since I became president of the United States, I just keep hearing ‘repeal and replace, repeal and replace.’ We’re starting that process and we’re starting it in a very positive manner.”
According to a White House press release, the order directs the Labor Department to consider loosening requirements for Association Health Plans, which allow individuals or small businesses to partner to purchase group insurance. By allowing employers in the same industry to offer group coverage across state lines, this order would give more Americans access to these types of plans.
Crucially, these plans are exempt from many of Obamacare’s coverage regulations, meaning these associations could offer slimmer, cheaper plans than those currently on the individual market.
Additionally, the order will expand short-term limited health insurance plans, which are stopgap measures designed to help those who temporarily lack access to more stable options, like people between jobs and people in counties with only a single insurer.
Sen. Rand Paul, who was present at the signing, praised it as “the biggest free market health reform of a generation.”
Although this new health-care effort is a new strategy for the White House, the basic metrics are the same: trying to lower coverage costs for people who want to buy smaller plans by exempting some people from Obamacare’s most onerous and expensive requirements. As a result, critics of the order are making largely the same case they made against previous efforts to repeal Obamacare—the more young and healthy people leave the individual market, the shakier that market becomes for older and sicker people.
“Creating an ‘uneven playing field’ between federally approved AHPs and the traditional insurance markets would result in higher premiums and fewer plan options for individuals and small employers buying insurance in the regulated individual and small-group markets,” Kevin Lucia and Sabrina Corlette wrote for The Commonwealth Fund on Tuesday.
The White House denies that its plan would leave the sick in the lurch, saying that “Employers participating in an AHP cannot exclude any employee from joining the plan and cannot develop premiums based on health conditions.”
The Heritage Foundation’s Ed Hailsmaier called the change a “modest positive,” but stressed that the most meaningful health-care reform would still require legislation.
“[Trump’s order] is recognizing that Obamacare has really created this bifurcated market, and it’s trying to provide relief to the people who have wound up being stuck with the disproportionate share of the cost in that market,” Hailsmaier told THE WEEKLY STANDARD. “It could have turned out differently, but you would have had to have written Obamacare differently, or rewrite it now.”
Hailsmaier also said the order was consistent with other health-care measures the Trump administration has pursued.
“Back when the president came out with his first executive order, right after he was sworn in, he was essentially saying this was a shift in emphasis,” Hailsmaier said. “The emphasis in the Obama administration had been to increase the number of subsidized people in the exchanges, heedless of whatever damage it does to the market outside the exchanges. And the new administration was signaling by this executive order back in January that they were going to take the position of trying to alleviate the cost and disruption that has occurred to the individual and small-group market, particularly outside the exchanges, and if that means that in the process there are fewer people signing up in the exchange, well, that’s okay with them. And I think this is consistent with that, that the focus of the administration has been on stabilizing the market particularly for people who are not subsidized.”
At the signing, Trump stressed that he would continue to push Congress to repeal and replace Obamacare.
“Today is only the beginning,” the president said. “In the coming months, we plan to take new measures to provide our people with even more relief and more freedom.”
This post originally appeared on Weekly Standard